A functional evaluation of cerebral perfusion for coronary artery bypass grafting patients

• Published in: Heart and vessels 2019-07, Vol.34 (7), p.1122-1131
• Main Authors: Teramoto, Chikao, Mutsuga, Masato, Kawaguchi, Osamu, Araki, Yoshimori, Matsuda, Joe, Usui, Akihiko
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiography; Aorta; Balloon treatment; Biomedical Engineering and Bioengineering; Blood flow; Blood vessels; Brain Ischemia - diagnostic imaging; Cardiac Surgery; Cardiology; Cerebral blood flow; Cerebrovascular Circulation; Computed tomography; Coronary artery; Coronary Artery Bypass, Off-Pump; Coronary vessels; Evaluation; Female; Grafting; Heart surgery; Homeostasis; Humans; Intra-Aortic Balloon Pumping; Intraoperative Care; Ischemia; Japan; Lesions; Magnetic resonance; Male; Medicine; Medicine & Public Health; Middle Aged; Occlusion; Original Article; Perfusion; Photon emission; Single photon emission computed tomography; Statistical analysis; Statistical significance; Stenosis; Stroke; Stroke - prevention & control; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-019-01348-7

We evaluate the utility of providing a pulsatile blood flow by applying off-pump coronary artery bypass grafting (CABG) or intra-aortic balloon pumping (IABP) with conventional CABG to prevent perioperative stroke in patients with cerebral hypoperfusion on single-photon emission-computed tomography (SPECT). A total of 286 patients underwent isolated CABG with a cerebral magnetic resonance angiography (MRA) evaluation between 2006 and 2015. Seventy-five had significant stenosis and/or occlusion of craniocervical vessels; the other 211 had no significant stenosis. Cerebral SPECT was performed for 49 (SPECT group) of the 75 patients. The SPECT group was further divided into a normal perfusion (NP) ( n  = 37); and a hypoperfusion (HP) ( n  = 12). In the present study we compared the NP group and the 211 patients with no significant stenosis (as a control group) to the HP group. No strokes occurred in the HP group, and 1 stroke occurred at the time of operation in the control group. Postoperative stroke within 30 days occurred in 3 patients in the control group; the difference was not statistically significant. The long-term stroke-free rates of the HP and Control group did not differ to a statistically significant extent. The functional evaluation of cerebral perfusion by SPECT is important when patients have significant stenotic lesions on cerebral MRA. Maintaining an adequate pulsatile flow by off-pump CABG or IABP with conventional CABG will help prevent perioperative stroke, even if cerebral hypoperfusion is detected by SPECT.